Screening

According to the BBC, there are some concerns over private health screening companies.

Health charities and government advisers say they have concerns about private medical screening to detect early signs of several diseases.

About 75,000 people in the UK have paid a US firm up to £150 for tests for conditions such as heart disease and strokes—often after getting letters.

Oh my goodness! They got letters? Quick, kill them all! Or something.

GPs say the letters are scaremongering and the tests are often unnecessary.

Hmmm. I might point out that it is surely up to individuals to decide whether or not they deem the tests necessary, no? It is up to the individual to decide whether they want to pay £150 for such a test, is it not?

Life Line Screening says it identifies risks and that NHS tests are only provided if patients display symptoms.

Well, this is entirely true. And I think that many people would like to know whether they are at risk of a stroke before they actually... you know... have a stroke.

Now, your humble Devil is no medico, but he does tend to think that people should make their own fucking decisions, rather than state-funded medicos doing it for them. In fact, as Ex-Pat Yank points out...

All told, the BBC report pulls together a remarkable alliance. Or, in other words, it rather boils down to this. According to that publicly funded TV channel, the “UK National Screening Committee” which is a government “advisory committee” housed within the government run health service, and charities that support that government “advisory committee’s” view, and GPs employed by that government run health service, all have serious reservations about private health screenings.

Is that a surprise?

Not really, no. Still the BBC does have the good grace to point out that those purchasing the services of Life Line Screening seem to be satisfied.

Customers spoken to by the BBC at a screenings said they were happy with the service, citing concerns over the length of time scans or tests can take on the NHS and the difficulty in obtaining appointments.

Naturally, the very next paragraph is...

But according to the body which advises the government on screening, the procedures offered by private companies such as Life Line Screening can be expensive, unnecessary and misleading.

The UK National Screening Committee says the NHS offers tests for osteoporosis, strokes and heart disease for free.

Fucking hell: how often must we say this—they are not "free". You have already paid for them and, as is entirely routine with the NHS, they will try their hardest to ensure that you either cannot get the scans, or that you do not get them until it is too fucking late.

Here's the beef: if these private screening companies are making false claims or anything similar, then they can be prosecuted under various Trading Acts: if they are not doing so, then might I suggest that the state and its employees—whose record on maintaining health is, to be frank, pretty fucking awful—shut the fuck up?

When you cunts have removed things such as C. difficile and MRSA (to pick just two examples) from our hospitals, then you might be able to pontificate. As Rod Liddle pointed out in the Guardian in 2003 and in The Spectator earlier this year, doctors have a pretty fucking special record.

Iatrogenesis accounts for the deaths of an estimated 72,000 British people every year — or slightly more than the combined numbers of those feckless people dying from smoking, drinking and being very fat. I suppose you could call it the silent killer; there are no government campaigns to educate the public about its lethality. When lists are published showing the top killer diseases it is never present, although it is the third most common cause of death.

The Chief Medical Officer, Sir Liam Donaldson, is not forever haranguing us about how we should avoid causes of iatrogenesis. I know of no medical pressure groups staffed by starch-shirted harridans screeching at us about the problem, nor taxes designed to prevent us from contracting it. And yet it is very easy to avoid iatrogenesis; all you need to do is never visit a hospital or a doctor, and indeed, if a doctor should approach you in a public place, then roll up your newspaper and swat him away, much as if he were a malarial mosquito, while holding your other hand tightly over your nose.

Iatrogenesis is the proper name for death by doctors. The latest figures I’ve seen, through the conduit of the Royal College of Physicians, is the one quoted above — a quite remarkable 72,000 deaths per year. Not all of them are the result of premeditated murder, of course; the overwhelming majority of victims are dispatched through pure incompetence or negligence. I am not sure if the figure includes those who die from infections generated in hospitals — my suspicion is, it does not. In which case you can add another 8,000 to the total, making a nice round figure of 80,000. Astonishing really, isn’t it?

And the vast, vast majority of that is "free" on the NHS. Aren't we lucky little serfs?

So, if people want to shell out £150 for private screenings (whatever their efficacy), I really think that the state health agencies should take a good look at themselves and...

... SHUT THE FUCK UP.

It's bugging me

Apparently, the government isn't doing too badly on MRSA rates.

The government is within touching distance of hitting its MRSA target, but opposition parties have accused ministers of manipulating the data.

NuLabour manipulate data? Surely not...

Latest figures show there were 1,072 cases of the superbug in England from July to September last year.

This approaches the target of half the 1,925 average quarterly 2003-4 figure.

But the Tories and Lib Dems accused ministers of moving the target back so it takes account of the period directly after the £50m deep clean of hospitals.

The latest quarterly figure represents an 18% fall on the previous quarter and comes after steady falls since September 2006. Decreases have also been seen elsewhere in the UK.

Well, NuLabour probably are manipulating the figures—I would be deeply surprised were they not—but surely any decrease in infections, especially in a steady downward trend, is a good thing, regardless?

That is good news. Let's move on, however, to the bad: that's right, it's yet another heart-warming story about how the government has happily rewarded failure with oodles of our cash.

BOM readers will recall Rose Gibb (see this blog). She's the ex-CEO of Maidstone and Tunbridge Wells NHS Trust ("Kent and Snuff It") who presided over the deaths of 90 patients from C difficile. Following a damning enquiry she was exited, but not before the Trust very nearly paid her £400 grand "compensation".

It was a particularly outrageous example of the public sector rewarding failure, and there was a huge public outcry. Commissar Johnson was forced to step in, promising he'd stop it.

Predictably enough he's failed: last week we learned Rose is still getting £75K, a lot more than the C diff victims of Kent and Snuff It will see.

Seventy five fucking grand? For presiding over the deaths of ninety people? Who the hell is negotiating these fucking contracts?

Oh, and what happened to that idea of prosecuting company bosses for corporate manslaughter? Is that still around or does it not apply to public sector workers? This silly bitch should be fighting to stay out of prison, not being rewarded with tons of our cash.

But what do the civil servants care? After all, it's all magic fucking money, that falls from the sky. Or, at the very least, it's not their money. No, it's not: it's ours. It's our fucking money, you bastards.

But the whole thing gets even more farcical.

Even more jaw dropping, she has now set up her own company—Resolve Healthcare Consulting Services—"to tell doctors and administrators how to give a better service to the public".

I find the idea that anyone who knows who she is will actually hire that company.

However, it wouldn't surprise me in the slightest if we find, somewhere not too far down the line, that the NHS has hired her company as a way of paying her the full compensation (whilst dodging the opprobrium for doing so).

Unbelievable though all this is, there is yet another dimension of ridiculousness. Yes, that's right: it can get worse...

Her partner in this venture is her partner in life, one Mark Rees, "who also quit a senior NHS job with an £170,000 payout amid claims of weak leadership after the trust he ran accumulated debts of £30million."

Advice on how to fail. Surely even our blinkered self-serving management consultant sucking health bureaucrats wouldn't be stupid enough to buy that.

Would they?

Resolve are curiously coy, for nowhere on the company's (very amateurish) website does it say exactly who Resolve are. The About Us page does contain this wonderful blurb though. [Emphasis mine.]

RESOLVE offers expert skills and knowledge from its people who have substantive NHS chief executive and executive director experience in NHS England and Wales, covering acute and specialist care, community services, mental health services and health authority management.

As I said above, don't be surprised if we find that at least £375,000 of NHS money (£400,000 initially proposed compensation - £75,000 "actual" compensation) finds its way to Resolve Healthcare Consulting Services sometime very soon. As Tyler says, we need to be very vigilant.

And, of course, anyone who can get hold of Resolve Healthcare Consulting Services's first year accounts will get a special pat on the back from your humble Devil...

Making a bad situation worse

It is not just Labour who want to install fines to enforce infection control, now the Tories want to start punishing NHS trusts for every case of hospital acquired infection. This kind of stupid idea could only have come from someone who has no understanding of the root causes of hospital acquired infections such as MRSA* and Clostridium difficile.

One rather misunderstood and worrying fact is that MRSA is now rather endemic in the community, outside of hospital, while many cases of Clostridium difficile also occur outside of hospital. That is not to say hospitals could not manage these problems better, of course they could, however would fining for failures really help improve the situation?

I would argue a very strong 'no'. Take Tunbridge Wells as a case in point, we can conduct a quick thought experiment here; here was a hospital in financial trouble with multiple management problems:

"Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair ... indicated that shortages of nurses contributed to the spread of infection ... The trust’s bed occupancy rates were consistently over 90% in the medical wards ... By definition for these areas there were no funds for dedicated staff, and at least initially they were staffed almost entirely by bank or agency nurses, bringing little continuity of care. Many of these factors increased the risk of transmission of infection."
...

"The lack of organisational stability, with numerous structural changes over the last three to four years, and a high turnover of senior managers, meant that managers could not settle into roles and focus on the key issues. Many felt there was little delegation. The style of management was described as reactive, with frequent changes of direction."
...

"... were preoccupied with finances, and had a demanding agenda for reconfiguration and private finance initiative (PFI), all of which consumed much management time and effort."

The factors contributing to this disaster were complex and included outdated buildings and wards, government targets and the excessive movement of patients, the inadequate isolation of patients, high bed occupancy rates, shortages in nursing numbers and a lack of continuity of care, and managerial malaise due to frequent restructuring and a preoccupation with financial issues.

Virtually all of these factors have been contributed too and massively worsened by the government's incessant interference and meddling with the NHS. A chronic underinvestment has left buildings and infrastructure outdated and unable to cope with modern infection control needs. Top down targets have led to the excessive movement of patients and the catalysis of infection spread. Falling acute bed numbers over the last ten years have led to bed occupancy levels rising to too high a level on average, a known factor in increasing hospital acquired infection. Centrally imposed deficits gave led to the financial pressures that result in key front line staff being laid off, while wards are left dangerously short staffed. While endless political interference in the structure of the NHS has resulted in reorganisation after reorganisation, a situation where no one knows their role, and consequently a system of no responsibility and accountability.

The government has let hospital acquired infection multiply out of control in recent years because it has simply not addressed the root causes aggressively enough. These ideas of fining failing trusts are completely misconceived and would make a bad situation worse. In fact several causal factors are still being worsened by direct action from central government, so the idea of central government fining people for things that it is directly contributing towards is nothing short of idiotic, while the fines would only accentuate the problems by worsening the causative financial pressures on the trust concerned. We currently have a situation where there is no accountability or responsibility, and if there was I have a distinct feeling that several of the people being held to account for this mess would be of the political variety. The politicians should be fining themselves.


* It is worth pointing out that, although it is now used as a general catch-all term for hospital acquired infections, MRSA is a specific bacterium: methicillin-resistant Staphylococcus aureus (methicillin is an anti-biotic from the same family as penicillin).—DK

Colonic irrigation Mr Brown?

It has been hot on the news in recent days that Gordon Brown is planning a 'deep clean', certain images do immediately spring to mind but unfortunately these instinctive thoughts are not exactly what Gordon means. His government and the Department of Health have both failed dismally in tackling MRSA and hospital acquired infections, in fact the UK has pretty much the highest MRSA rates in Europe. Gordon's 'deep clean' is akin to a sticky plaster being used to close a gaping abdominal wound, he wants to be seen to be doing something when he clearly is not.

The reasons for our failure to tackle hospital acquired infections and MRSA are complex, but arguably revolve around a complete failure to tackle the problem in an all encompassing manner; our government has been using multiple sticky plasters, when in reality the patient needs to return to theatre to have a proper sorting. In fact superficial measures enforced by fascist managers that have no decent evidence base are the routine in the NHS. Gordon's deep clean in the latest in a very long line of crappy gimmicks.

The battle against hospital acquired infection is being lost largely because the government's top down targets force patients to be pointlessly moved from ward to ward so quickly that infection gets the opportunity to spread, and because bed numbers have been on the fall meaning that we do not have the capacity to isolate MRSA carriers and high risk patients from others. The gathering of targets based for political propaganda are more important to Mr Brown than designing a holistic approach to these complex problems.

I suggest that Mr Brown should conduct a vigorous 'deep clean' of a few New Labour orifices that are resting a little closer to home, as I am getting rather tired of their misinformed faeculent deposits. Mr Brown would be better off getting his own house in order and letting medical experts, not politicians, decide how to best manage medical problems. Possibly Mr Brown is a little scared about what might turn up if he gave the New Labour colon a thorough cleansing; who knows, there may be a peerage or two impacted together in a rather hard to reach crevasse?